Ranking of the Rate of State Medical Boards’
Serious Disciplinary Actions in 2003 (HRG Publication #1696)

Every April, the Federation of State Medical Boards releases its report on serious disciplinary actions taken in the previous year. As soon as the 2004 report is issued, we will have a new ranking of the State Medical Boards.

Public Citizen’s Health Research Group

Ranking of the Rate of State Medical Boards’
Serious Disciplinary Actions in 2003

April 14, 2004

Sidney M. Wolfe, M.D.
Peter Lurie, M.D., M.P.H.

Based on data from the Federation of State Medical Boards (FSMB) on the number of disciplinary actions taken in 2003 against doctors, Public Citizen’s Health Research Group has calculated the rate of serious disciplinary actions (revocations, surrenders, suspensions and probation/restrictions) per 1,000 doctors in each state and compiled a national report ranking state boards by the rate of serious disciplinary actions per 1,000 doctors in the year 2003 (See Table 1).

Our calculation of rates of serious disciplinary actions (revocations, surrenders, suspensions and probations/restrictions) per 1,000 doctors by state is created by taking the number of such actions (columns A and B from the FSMB data) and dividing it by the American Medical Association data on nonfederal M.D.s as of December 2002[1](adding to this the number of osteopathic physicians[2] if the board is a combined M.D./D.O. board). We then multiplied the result by 1,000 to get state disciplinary rates per 1,000 physicians.

Because some small states do not have many physicians, an increase or decrease of one or two serious actions in a year can have a much greater effect on the rate of discipline in such states than it would in larger states. Therefore, starting with this year, we are calculating the three-year average rate of discipline (for each year and the preceding two years) for all states and listing them by rank so that trends over the past decade can more accurately be examined (see Table 2). As of next year (for the disciplinary data for 2004), we will only be reporting 3-year averages which, for next year, will be the average of the disciplinary rates for 2002, 2003 and 2004.

There were 2,992 serious disciplinary actions taken by state medical boards in 2003, up 4.5% from the 2,864 serious actions taken in 2002. State rates ranged from 1.46 serious actions per 1,000 physicians (Rhode Island) to 11.58 actions per 1,000 physicians (Kentucky), a 7.9-fold difference between the best and worst states. If all the boards did as good a job as the lowest of the top five boards---the rate for #5, Oklahoma, being 7.88 serious disciplinary actions per 1,000 physicians or 0.788 percent---this would have amounted to a total of 6,638 (0.788 percent of 842,379 non-federal doctors) serious actions a year. This would be 3,646 more serious actions than the 2,992 that actually occurred in 2003, an increase of 121%.

Worst States (those with the lowest rate of serious disciplines).

As can be seen in Table 1, the bottom 15 states, those with the lowest serious disciplinary action rates in 2003, were, starting with the lowest: Rhode Island (1.46 actions per 1,000 physicians), Wisconsin (1.66 per 1,000 physicians), Minnesota (1.67 per 1,000 physicians), Delaware (1.71 per 1,000 physicians), Michigan (1.77 per 1,000 physicians),

Table 2 shows that five of these 15 states, (Wisconsin, Minnesota, Tennessee, Delaware, and Hawaii) have consistently been in the bottom 15 states for nine consecutive 3-year average periods. Pennsylvania and Illinois have been in the bottom 15 states for eight of the last 3-year average periods. Large decreases in rates and rankings occurred for states such as Mississippi, in the top 10 states for seven consecutive 3-year averages until 2001 (the average of 1999, 2000 and 2001) but falling substantially since then to 20th for the latest 3-year average. Similarly Arkansas, in the top 10 states in the late 1990’s, has fallen sharply to 29th since the 2000 3-year average in the last several years. Michigan, which was rated 14th or 15th in the late 1990’s has sunk to 40th. Looked at another way, 10 of the bottom 15 states, as measured by the rate of discipline in 2003 alone, were also in the bottom 15 for 2003 using the new 3-year moving average (the average rates for 2001, 2002 and 2003).

These data again raise serious questions about the extent to which patients in many states with poorer records of serious doctor discipline are being protected from physicians who might well be barred from practice in states with boards that are doing a better job of disciplining physicians. It is extremely likely that patients are being injured or killed more often in states with poor doctor disciplinary records than in states with consistently high performance.

As can be seen in Table 2, three of these 10 states (Wyoming, Oklahoma and Alaska) have been in the top ten for all nine of the three-year average periods listed. Ohio has been in the top 10 of these three-year average periods for seven of the last nine, Kentucky, North Dakota and West Virginia for six of the last nine, and Arizona for five of the last nine.

With the exception of Vermont, which has improved considerably over the past several years, all of the other nine top-10 states, as measured by the rate of serious disciplinary actions in 2003 alone, were also in the top ten as measured by the 2003 3-year average (2001, 2002 and 2003).

What Makes a Difference?

Boards are likely to be able to do a better job in disciplining physicians if most, if not all, of the following conditions are true:

Adequate funding (all money from license fees going to fund board activities instead of going into the state treasury for general purposes)

Adequate staffing

Proactive investigations rather than only following complaints

The use of all available/reliable data from other sources such as Medicare and Medicaid sanctions, hospital sanctions and malpractice payouts

Excellent leadership

Independence from state medical societies and other parts of the state government

A reasonable statutory framework for disciplining doctors (preponderance of the evidence rather than beyond reasonable doubt or clear and convincing evidence as the legal standard for discipline).

It is clear that state-by-state performance is spotty. Only one of the nation's 15 largest states, Ohio, is represented among those 10 states with the highest disciplinary rates. Illinois and Pennsylvania, other large states, have consistently been near the bottom and California and New Jersey have hovered around the middle. Massachusetts, consistently in the bottom 15 states for the three-year averages until the 2001 three-year average, has improved substantially since then.

Given the importance of medical boards in protecting patients from doctors who are not practicing medicine in the best manner and are thus endangering the lives and health of residents, most states are not living up to this obligation. Serious attention must be given to finding out which of the above variables are deficient in each state. Then action must be taken, legislatively and through pressure on the medical boards, to increase the amount of discipline and, thus, the amount of patient protection.

[1] Physician Characteristics and Distribution in the U.S. American Medical Association, 2004 Edition.[2] Fact Sheet: American Osteopathic Association. Statistics as of June, 2002.

Table 2: Ranks Based on Average Doctor Disciplinary Rates Over Three Years*

State

1995

1996

1997

1998

1999

2000

2001

2002

2003

Alabama

40

39

36

27

18

14

12

11

13

Alaska

5

3

3

1

1

1

1

1

6

Arizona

11

9

7

13

28

18

5

3

1

Arkansas

28

24

16

9

5

8

15

20

29

California

31

32

20

22

22

23

25

24

22

Colorado

9

5

5

6

12

19

16

12

9

Connecticut

28

37

33

37

39

37

39

38

38

Delaware

48

47

44

49

50

50

50

49

50

District of Columbia**

51

51

49

40

42

N/A

N/A

N/A

41

Florida

26

19

22

44

46

44

33

36

37

Georgia

6

8

11

16

16

10

10

10

15

Hawaii

50

49

50

46

48

47

49

50

51

Idaho

36

36

34

25

13

22

14

18

14

Illinois

42

48

41

42

38

45

47

41

36

Indiana

14

20

25

26

19

20

27

32

33

Iowa

3

2

2

4

8

13

8

9

12

Kansas

33

29

38

36

45

43

32

30

30

Kentucky

8

11

12

12

10

5

4

5

2

Louisiana

12

18

26

28

23

21

24

19

17

Maine

39

28

23

14

17

17

29

28

34

Maryland

23

28

37

41

41

38

41

45

47

Massachusetts

46

41

46

48

46

46

37

34

23

Michigan

32

34

19

15

14

15

20

27

40

Minnesota

41

46

48

50

49

48

48

47

48

Mississippi

4

1

1

2

2

6

9

14

20

Missouri

16

26

31

28

34

34

28

29

31

Montana

10

12

15

20

25

36

30

16

8

Nebraska

37

27

40

28

43

40

45

28

28

Nevada

21

15

13

19

29

26

22

25

32

New Hampshire

49

50

51

47

30

25

18

23

24

New Jersey

19

17

24

34

37

30

26

21

25

New Mexico

38

30

27

23

27

24

34

26

21

New York

29

21

17

18

15

12

13

13

18

North Carolina

22

43

32

32

24

28

31

37

42

North Dakota

24

10

14

7

6

2

2

2

3

Ohio

15

13

8

10

7

7

7

7

7

Oklahoma

7

6

6

3

4

4

3

4

5

Oregon

18

16

21

30

31

28

23

17

16

Pennsylvania

47

45

39

39

40

39

36

39

45

Rhode Island

30

24

18

17

21

29

38

40

46

South Carolina

20

33

43

33

28

31

43

44

44

South Dakota

13

22

28

24

20

32

46

48

28

Tennessee

44

42

47

51

51

49

44

42

43

Texas

25

23

28

31

33

33

28

33

26

Utah

45

38

30

21

26

16

11

8

11

Vermont

16

14

10

11

11

9

19

31

19

Virginia

34

40

45

45

32

27

21

22

27

Washington

27

31

29

38

36

41

40

43

39

West Virginia

1

7

9

8

9

11

17

15

10

Wisconsin

43

44

42

43

44

42

42

46

49

Wyoming

2

4

4

5

3

3

6

6

4

*Each year, a disciplinary rate was calculated. For each year, a moving average rate was calculated by adding the rate in that year to the rate in the two preceding years and dividing by three. This rate was then ranked. The ranking in the column marked “2003” thus represents the ranking of that states average rate over the period 2001-2003.